Anatomy and biomechanics of the TMJ

By Dr. Rabia Aziz

INTRODUCTION

Area Of Craniomandibular Articulation Mandibular condyle Mandibular fossa of the temporal bone. Ginglymoarthrodial Joint Ginglymoid joint hinging movements. Arthrodial joint gliding movements. Compound Joint a joint requires presence of at least three bones. Synovial Joint synovial fluid

TMJ - LOCATION

Anatomy Of The TMJ

Structures involved are:

Mandibular condyle Mandibular fossa of the temporal bone. Articular disc

Articular Disc

Sagittal Plane
It can be divided into three regions: Intermediate zone thinnest zone Anterior region thicker zone Posterior region thickest zone

1. 2. 3.

Frontal View

thicker medially than laterally

Posterior Attachments Of The Articular Disc

Bilaminary Zone

1. Retrodiscal tissue
2. Retrodiscal lamina

Posterior Attachments Of The Articular Disc

i. Superior retrodiscal lamina: It attaches the articular disc posteriorly to the tympanic plate.

Posterior Attachments Of The Articular Disc

ii. Inferior retrodiscal lamina:
It attaches the inferior border of the post edge of the disc to the post margin of the articular surface of the condyle.

Anterior Attachments Of The Articular Disc

1.

2.

3.

Superior attachment: It is to the ant. margin of the articular surface of the temporal bone. Inferior attachment: It is to the ant margin of the articular surface of the condyle. Middle attachment: It is to the superior lateral pterygoid muscle by tendinous fibers.

Lateral and medial attachments of the articular disc

These divide the joint into two cavities: 1. Upper or superior cavity 2. Lower or inferior cavity

TMJ SYNOVIAL JOINT

Synovial Lining secretion of synovial fluid. Purpose of the synovial fluid i. Acts as a medium for metabolic requirements. ii. Acts as a lubricant to reduce friction. Mechanisms of lubrication There are two mechanisms: i. Boundary lubrication ii. Weeping lubrication

LIGAMENTS

Protect the structures in any joint system. Made up of collagenous connective tissue. can not be stretched due to above said characteristic. Limit and restrict joint movements within normal limits.

Ligaments Related To TMJ

1. 2. 3.

1.
2.

There are three functional ligaments related to TMJ: Collateral (discal) ligaments Capsular ligaments Temporomandibular ligaments There are also two accessory ligaments: Sphenomandibular Stylomandibular

Collateral (Discal) Ligaments

Attach the medial and lateral borders of the articular disc to the poles of the condyle. Divide the joint mediolaterally into superior and inferior joint cavities. Restrict movement of the disc away from the condyle. Responsible for hinging movement of TMJ which occurs between the condyle and the articular disc.

Capsular Ligaments

Surrounds the entire TMJ. Superiorly, attached to the temporal bone along the borders of the articular surfaces of the mandibular fossa and articular eminence. Inferiorly, attached to the neck of the condyle. Resist any medial, lateral or inferior forces that tend to separate or dislocate the articular surfaces. Retain the synovial fluid.

Temporomandibular Ligament

1. 2.

Reinforced the lateral aspect of capsular ligament. Composed of two parts Outer oblique portion Inner horizontal portion

1. Outer Oblique Portion

Extends from the outer surface of the articular tubercle and zygomatic process posteroinferiorly to the outer surface of the condylar neck. Acts to limit the extent of mouth opening Resists the impingement of mandible on the vital submandibular and retromandibular structures of the neck.

2. Inner Horizontal Portion

Extends from outer surface of the articular tubercle and zygomatic process posteriorly and horizontally to the lateral pole of the condyle and posterior part of the articular disc Limits posterior movement of the condyle and disc. Protects the retrodiscal tissues from trauma. Protects the lateral pterygoid muscle from overlengthening or extension.

Accessory Ligaments
1.

Sphenomandibular Ligament
Arises from the spine of the sphenoid bone and extends downward to a small bony prominence on the medial surface of the ramus of the mandible called the lingula. Not have any significant effects on mandibular movement

2.Stylomandibular Ligament

Arises from the styloid process and extends downward and forward to the angle and posterior border of the ramus of the mandible. Limits excessive protrusive movements of the mandible by becoming taut.

Muscles Of Mastication
There are four pairs of muscles: 1. Masseter 2. Temporalis 3. Medial pterygoid 4. Lateral pterygoid.

1. Masseter

Originate from zygomatic arch and extends downward to the lateral aspect of the lower border of the ramus of the mandible.

Superficial portion runs downward and slightly backward Deep portion runs predominantly in vertical direction. Action elevate and protrude the mandible

2. Temporalis

Originate from temporal fossa and the lateral surface of the skull. All fibers come together as they extend downward between the zygomatic arch and lateral surface of the skull to form a tendon that inserts on the coronoid process and anterior border of the ascending ramus.

Anterior Fibers elevate the mandible Middle And Posterior Fibers elevate and retrude the mandible.

3. Medial Pterygoid

Originates from pterygoid plate and extends downward, backward and outward to insert along the medial surface of the mandibular angle. Action elevate and protrude the mandible

4. Lateral Pterygoid
This muscle has two bellies 1. Inferior belly Originates at the outer surface of the pterygoid plate and extends backward upward and outward to its insertion primarily on the neck of the condyle.

2.

Superior belly
Originates at the infratemporal surface of the greater sphenoid wing, extending almost horizontally, backward and outward to insert on the articular capsule, the disc and the neck of the condyle.

Action:
Protrusion of the mandible Side to side movement

1. 2.

Biomechanics Of The TMJ

The TMJ is a compound joint. Its structure and function can be divided into two distinct systems: Inferior Joint System Superior Joint System

1. 2.

1.

Inferior Joint System composed of condyle and articular disc. Disc is tightly bound to the condyle by lateral and medial discal ligaments Only physiologic movement that can occur here is rotation of the disc on the articular surface of the condyle.

2.

Superior Joint System

Here condyle-disc complex functions against the surface of the mandibular fossa. Disc is not tightly attached to the mandibular fossa Sliding movements (translation) are possible here.

Stability maintained by constant activity of the muscles that pull across the joint, primarily the elevators. Even in resting stage, these muscles are in a mild stage of contraction called tonus. Interarticular pressure increases as muscle activity increases. Width of the articular disc varies with the interarticular pressure.

Superior retrodiscal lamina retracts the disc posteriorly on the condyle. The interarticular pressure and morphology of the disc prevent the disc from being overretracted posteriorly. Superior lateral pterygoid muscle protracts the disc anteriorly and medially. Anterior capsular ligament and inferior retrodiscal lamina force the disc to translate forward with the condyle.

Tonus of the superior lateral pterygoid muscle is greater than the superior retrodiscal lamina. At rest, with the mouth closed the condyle will normally be in contact with the intermediate and posterior zones of the disc.

LIGAMENTS AND MUSCLES INVOLVED

MAKING IT RIDICULOUSLY EASY

Basic Orthopedic Principles Related To TMJ

1.

2.

Ligaments do not actively participate in function of the TMJ. They act as guide wires, restricting certain joint movements while permitting others. Ligaments do not stretch. If traction force is applied, they can become elongated which leads to compromised joint function.

3.

The articular surfaces of TMJ must be maintained in constant contact. This contact is produced by the muscles that pull across the joint ( the elevators: temporal, masseter, and medial pterygoid). A sound understanding of these principles is necessary for the evaluation and treatment of the various disorders.